Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents

Abstract

Objective To examine the incidence and risk factors of any-cause reoperation after primary ACLR in children and adolescents. Design Retrospective Cohort Setting Electronic medical records from a large tertiary care, single institution integrated healthcare delivery system. Patients Patients were under the age of 18 years and had anterior cruciate ligament reconstruction. They were excluded if they had a multi-ligamentous knee injury or <1 year follow-up. Interventions Patients were further identified to have undergone a subsequent knee operation ipsilaterally or contralateral ACLR. Main outcome measures The rate of any-cause reoperation was our primary outcome measure. Results The median age was 16. There were 208 females (53.9%) and 178 males (46.1%) included. The median follow-up was 25 months with a minimum of 12 months (interquartile range: 16.0, 46.0). The rate of any-cause reoperation was 34.7%. There was no statistically significant difference between those who underwent reoperation versus those who did not undergo reoperation relative to age, sex, BMI, graft type, or the presence of concomitant meniscal injury. The rates of ipsilateral ACLR and contralateral ACLR at any time during the study period was 8.0% and 10.9% respectively. There was no statistically significant difference for rate of reoperation between graft types, between various concomitant injuries, between those who underwent meniscus repair or no repair. Conclusions This study reflects a 34.7% rate of a subsequent knee operation after ACLR in patients younger than 18 years. These findings can be used to inform pediatric patients undergoing primary ACLR on their risk of returning to the operating room.

Machine learning can accurately predict risk factors for all‐cause reoperation after ACLR: creating a clinical tool to improve patient counseling and outcomes

“…In this study, there was a 16% rate of all‐cause reoperation after ACLR. There are varying percentages available in the current literature; however, 16% is likely less than the reported average [20, 33, 44]. Van Dijck et al reported a reoperation rate of 27.6% with an average follow‐up of 7.4 years.…”

“…Although meniscal repair is generally a successful procedure, as studies continue to show improved survival of cartilage, and slower progression to end stage degenerative joint disease after meniscal repair, surgeons must be conscious of the risk of reoperation associated with concomitant meniscal repair and ACLR [45]. Similarly, although hamstring autografts help to prevent the risk of anterior knee pain in our younger patients, they have shown higher graft failure rates after ACLR [12], especially in younger patients who are already at risk for reoperation [18, 33]. Interestingly, there is minimal data in the current literature for the most prominent feature of our model: diagnosis of systemic inflammatory disease.…”

“…Anterior cruciate ligament (ACL) injury is the most common cause of ligamentous knee injury requiring surgery and the incidence of ACL reconstruction (ACLR) continues to rise [9, 37]. Although a generally successful surgery, reoperations after ACLR are common [20, 33, 44]. As incidence of ACLR increases, there is heightened need in orthopedic literature to investigate the clinical course of patients after reconstruction.…”